Over 50% of the 700,000 individuals who survive a stroke each year have persistent movement impairments. Intensive rehabilitation could reduce their impairments, but access to such therapy is limited. Home therapy could supplement time with a therapist, but the current standard of care is simply providing individuals printed sheets of exercises, an approach that is not motivating and often not effective. Technological solutions do exist, but they are either too expensive or are only intended to treat a small subset of the broad range of movement impairments individuals with stroke experience, which has limited their wide spread adoption. The goal of this Phase II SBIR is to develop and test RehabTouch, a mixed-reality gym for motivating and monitoring hand, arm, trunk, and leg exercises after stroke. RehabTouch is an affordable rehabilitation tool consisting of two wireless input devices called pucks that each contain an array of sensors. The pucks connect to a software application that can direct users to perform exercises that are appropriate for their specific impairments and then detect when repetitions of those exercises are completed. We have shown that RehabTouch can detect the completion of 40 different exercises, and that individuals with even severe motor impairment after stroke are able to complete hundreds of repetitions with RehabTouch and find the system to be motivating, valuable, and easy to use. We thus hypothesize that home therapy with RehabTouch will be feasible for individuals with a broad range of impairments, and more motivating and effective than the current standard of practice, printed sheets of exercises. The aims of this Phase II grant are to: 1) Implement a comprehensive library of hand, arm, trunk, and leg exercises appropriate for individuals with mild, moderate, and severe motor impairments by partnering with experienced PTs and OTs; 2) Develop a data-driven exercise personalization system for RehabTouch that recommends appropriate exercises and intensity levels for individual users; and 3) Determine the safety and effectiveness of home-based movement training with RehabTouch for improving motor function in a randomized controlled trial with individuals with subacute stroke (N = 50). We hypothesize that individuals who exercise with RehabTouch will exercise for a longer duration, and have significantly greater increases in Fugl- Meyer score and other impairment- and function-related outcomes than individuals who perform conventional therapy. We will also analyze the data from this study to determine if RehabTouch is appropriate for individuals with a broad range of impairments. If successful, this project will result in a commercially-ready, clinically validated home therapy tool that could become widely adopted in actual practice, thus reducing long term movement impairments after stroke.